Surgical expertise at Lariboisière

Un anévrisme est une malformation artérielle qui naît au niveau d'une zone de fragilité de la paroi, entraînant une dilatation appelée sac anévrismal, dans lequel le sang circule et qui peut se rompre.

How does an aneurysm manifest itself?

Intraoperative photograph of a cerebral aneurysm.

An aneurysm most often presents with rupture, which causes a subarachnoid hemorrhage, i.e., blood spreading into the subarachnoid spaces around the brain. Sometimes, rupture also causes bleeding within the brain, forming an intracerebral hematoma.

This is a serious condition in the event of rupture and requires urgent, specialized multidisciplinary management involving a neurosurgeon, an interventional neuroradiologist, and a neuro–intensive care team.

More rarely, an aneurysm may present through the compression it exerts on adjacent structures, such as the nerves responsible for eye movement, leading to double vision.

Lastly, aneurysms are now often discovered incidentally due to the increasing use of brain imaging examinations (CT scan, MRI). In this case, the question of treatment depends on several factors:

The patient’s age
The risk of bleeding, which itself depends on the size of the aneurysm, its location, its shape, and associated risk factors.
The risk of treatment

Treatment of an unruptured aneurysm is discussed at a multidisciplinary meeting bringing together neurosurgeons and interventional neuroradiologists.

How is an aneurysm treated?

The two treatment options are microsurgery and embolization. In complex cases, such as a giant aneurysm, a combined procedure (surgical clipping and/or bypass associated with endovascular treatment) may be proposed to reduce risks and optimize the therapeutic outcome.

The prognosis is very good in the vast majority of cases when preventive elective treatment is performed before rupture. By contrast, it is serious or even very serious in the event of rupture, due to the consequences of bleeding. This is why the risk of rupture must be assessed carefully: beyond a certain size or in the case of an irregular shape, preventive treatment of the aneurysm is most often preferred.

Treatment of a cerebral aneurysm with coils and a clip — Treatment with coils (left) and a clip (right). The clip is applied to the neck of the aneurysm.

Microsurgery (clipping)

The surgeon accesses the aneurysm via a craniotomy and places a metal clip at the base of the aneurysmal sac (the neck) to exclude it from the bloodstream while preserving adjacent arteries.
Endovascular embolization (coiling)

Via the arterial route (without opening the skull), the interventional neuroradiologist introduces micro-coils into the aneurysmal sac to induce thrombosis and exclude it from the circulation.
Combined treatment

In complex cases (giant aneurysm, unfavorable anatomy), a procedure combining surgical clipping and endovascular treatment may be proposed to optimize the therapeutic outcome.

Aneurysm rupture causes a sudden headache described as “a thunderclap.” The pain is generally located at the back of the neck, or it may be a very severe, diffuse pain that is especially sudden, followed by more moderate but persistent pain over the following hours and days. In the event of more significant bleeding or rebleeding, the level of consciousness.

Risk factors

Recognized predisposing factors

High blood pressure
Active smoking
Alcoholism
Certain rare diseases such as familial polycystic kidney disease
Rare forms of familial aneurysms

Bleeding frequency and risk

The incidence is estimated at 2% of the general population, with an annual bleeding risk of less than 1% per year.

For more information

Treatment of a ruptured aneurysm may be surgical or endovascular.
Following a ruptured aneurysm, a prolonged stay in intensive care is required, the duration of which varies depending on severity and complications. Admission to a rehabilitation center may also be necessary depending on residual deficits.
Fatigue, anxiety, and memory and concentration disorders are often present in the long term, but are managed by a speech therapist or neuropsychologist.
Preventive treatment of an unruptured aneurysm is decided during joint meetings between the neurosurgeon and the interventional neuroradiologist. Some will be monitored.
Some more complex aneurysms, extremely rare giant aneurysms, may require combined neurosurgical and endovascular treatment and/or more complex surgical treatment combining a bypass and clipping of the
aneurysm.

The therapeutic risk is higher and may reach 10%.

 Preferred approach All aneurysms managed are evaluated in multidisciplinary consultation (interventional neuroradiologist and neurosurgeon). Monitoring is preferred for small aneurysms. Sylvian aneurysms are more often operated on, whereas those in other locations are often embolized.  Department-specific expertise Complex procedures /Bypass Who will take care of you?  Lead surgeon: Dr Anne-Laure BERNAT  Associated team: Interventional neuroradiology team (Dr Alexis GUEDON) Frequently asked questions (FAQ)  Length of hospital stay 2 to 3 days for unruptured aneurysms Minimum 1 month for ruptured aneurysms  Surgical risks The therapeutic risk of an unruptured aneurysm is estimated at 2.5% and is the occurrence of an ischemic stroke with motor, language, and/or neurocognitive sequelae.  Long-term follow-up Follow-up of a surgically treated aneurysm is performed with CT angiography approximately every 2 years for 6 years, then follow-up is spaced out. An angiographic check is proposed within the 2 months following surgery, as this examination provides more anatomical detail and the result may determine the frequency and modalities of follow-up.

Guide

Prospective Patients

Your stay is our priority, and we have established a patient pathway program for your surgical schedule, admission and intervention, through to your discharge. Please do not hesitate to contact us if you have any questions.

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